邬嘉琛从脾胃论治糖尿病肾病经验

Wu Jia-chen's Experience of Treating Diabetic Nephropathy from Spleen and Stomach

邬嘉琛教授认为糖尿病肾病早期以脾肾气阴两虚为主,患者常表现为乏力、口干、口渴、腰膝酸软等症,治疗上主张"补肾不如补脾",处方以健脾益气为主,常用四君子汤加味;糖尿病肾病中后期湿浊证较为突出,湿阻脾胃,使胃失和降,表现为纳呆、腹胀、恶心、呕吐等症,邬老师根据"六腑以通为用"的理论,治以通降胃气,常用半夏泻心汤合枳术丸加减。糖尿病肾病患者多存在严重水肿,水肿初期以水湿为主,邬老师强调,祛湿当先健脾,常用胃苓汤加减。邬老师遣方用药时强调:一,应用补益药物时,注重理气醒脾,以防滋腻碍胃。二,应用清热利湿药物时,避免大苦大寒,以防苦寒败胃。三,用生姜、大枣、甘草调养胃气。四,服药期间饮食要有禁忌,避免辛辣伤胃。

Professor Wu Jia-chen believes that the early stage of diabetic nephropathy is characterized by deficiency of both qi and yin of the spleen and kidney,and the patients are often manifested as fatigue,dry mouth,thirst,soreness of the waist and knees. In terms of treatment,it is advocated that " reinforcing the spleen is better than tonifying the kidney " . The prescription is based on strengthening the spleen and supplementing qi,and Supplemented Four Gentlemen Decoction is commonly used. Diabetic nephropathy patients in the middle and late stages has more prominent dampness syndrome. When dampness obstructs the spleen and stomach,and the stomach loses harmony and fails to descend,the patients will be manifested as anorexia,abdominal distention, nausea,vomiting and other symptoms. According to the theory that the six Fu-organs should be dredged,Professor Wu uses Pinellia Heart-Draining Decoction in combination with Modified Immature Bitter Orange and Atractylodes Macrocephala Pill to dredge and descend stomach qi. Diabetic nephropathy patients mostly have severe edema,and water-based edema in the early stage,so Professor Wu stresses that the first step to remove dampness is to invigorate the spleen,Modified Stomach-Calming Poria Decoction is often used. In terms of using drugs in a formula,Professor Wu emphasizes the following four points: First,when applying tonic drugs,we should pay attention to regulating qi and invigorating the spleen,so as to prevent greasy food from obstructing the stomach. Second,when use drugs for clearing heat and promoting urination,extremely bitter and cold drugs should be avoided to prevent the stomach from hurting. Third,Shengjiang ( Rhizoma Zingiberis Recens) ,Dazao ( Fructus Jujubae) ,Gancao ( Radix et Rhizoma Glycyrrhizae) should be used to recuperate the stomach qi. Fourth,there should be taboos to avoid eating spicy food during the period of taking medicine.